[104-10222-10040.pdf — page 161]
26 ARE YOU A CITIZEN OF OR DO YOU OWE ALLEGIANCE TO THE UNITED STATES?27 ARE YOU, OR HAVE YOU EVER BEEN A MEMBER OF THE COMMUNIST PARTY U.S.A. OR ANY COMMUNIST ORGANIZATION?28 ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF A FASCIST ORGANIZATION?29 ARE YOU NOW OR HAVE YOU EVER BEEN, A MEMBER OF ANY ORGANIZATION, ASSOCIATION, MOVEMENT, GROUP OR COMBINATION OF PERSONS WHICH IS COMMUNIST, FASCIST, TOTALITARIAN, OR WHICH ADVOCATES OR APPLIES ADVOCATING (1) THE OVERTHROW OF THE CONSTITUTION OR LAWS OF THE UNITED STATES BY FORCE, VIOLENCE OR SUBVERSION OR (2) SEEKING TO DENY OTHER PERSONS THEIR RIGHTS UNDER THE CONSTITUTION OF THE UNITED STATES BY UNCONSTITUTIONAL MEANSIf your answer to question 27, 28, or 29 above is "yes," state in Item 39 the names of all such organizations, associations, movements, groups, or combination of persons and dates of membership. Give complete details of your activities therein and describe any explanation you desire regarding your membership activities therein.30 SINCE YOUR 16th BIRTHDAY, HAVE YOU EVER BEEN ARRESTED, INDICTED OR SUMMONED INTO COURT AS A DEFENDANT IN A CRIMINAL PROCEEDING, OR CONVICTED, FINED, OR IMPRISONED OR PLACED ON PROBATION OR HAVE YOU EVER BEEN REQUIRED TO DEPOSIT BAIL OR COLLATERAL FOR THE VIOLATION OF ANY LAW, POLICE REGULATION OR ORDINANCE (EXCLUDING TRAFFIC VIOLATIONS FOR WHICH A FINE OR FORFEITURE OF $25 OR LESS WAS IMPOSED)?If your answer is "Yes," list all such cases under Item 39 below. Give in each case (1) the date; (2) the nature of the offence or violation; (3) the name and location of the court; (4) the penalty imposed, if any, or other disposition of the case. If fingerprinted, your fingerprints will be taken.31 HAVE YOU BEEN DISCHARGED OR FORCED TO RESIGN FOR MISCONDUCT OR UNSATISFACTORY SERVICE FROM ANY POSITION?If your answer is "Yes," give in Item 39 the name and address of employer, date, and reason in each case.32 HAVE YOU EVER BEEN CANCELLED FROM THE U.S. CIVIL SERVICE COMMISSION FROM TAKING TESTS OR ACCEPTING CIVIL SERVICE APPOINTMENT?If your answer is "Yes," give dates of and reasons for such debarment in Item 39.35 ARE YOU AN OFFICIAL OR EMPLOYEE OF ANY STATE, TERRITORY, COUNTY OR MUNICIPALITY?If your answer is "Yes," give details in Item 39.36 DOES THE UNITED STATES GOVERNMENT EMPLOY IN A CIVILIAN CAPACITY ANY RELATIVE OF YOURS (BY BLOOD OR MARRIAGE) WITH WHOM YOU LIVE OR HAVE LIVED WITHIN THE PAST 24 MONTHS?If your answer is "Yes," show in Item 39 for EACH such relative (1) full name; (2) present address; (3) relationship; (4) Department of Agency by which employed; and (5) kind of appointment.SPECIAL INSTRUCTIONS FOR CLAIMING VETERAN PREFERENCEA. If you are claiming preference as a PEACETIME VETERAN who has been awarded a campaign badge for service during a war or expedition or a DISABLED VETERAN or as the WIDOW OF A WAR OR CAMPAIGN VETERAN, file Veteran Preference Claim, CSC Form 14, together with proof specified therein.B. If you are a WAR-TIME VETERAN NOT claiming disability preference, you should NOT submit your discharge with this application. Preference will be tentatively credited to you and if appointed, you will be required to submit to the appointing officer prior to entry on duty, official evidence of separation from active service in the armed forces of the United States in time of war.37 (A) WERE YOU EVER IN THE UNITED STATES MILITARY OR NAVAL SERVICE DURING TIME OF WAR?(B) IS THE WORD "HONORABLE" OR THE WORD "SATISFACTORY" USED IN YOUR DISCHARGE OR SEPARATION PAPERS TO SHOW THE TYPE OF YOUR DISCHARGE OR SEPARATION?(C) WAS SERVICE PERFORMED ON AN ACTIVE FULL-TIME BASIS WITH FULL MILITARY PAY AND ALLOWANCES?(D) DATE OF ENTRY OR ENTRIES INTO SERVICE DATE OF SEPARATION OR SEPARATIONSSept, 1943 March 1945BRANCH OF SERVICE (Army, Navy, SERIAL NO. (if none, give grade or Marine Corps, Coast Guard, etc.) rating at time of separation)Army 3522865838 IF YOU SERVED IN THE UNITED STATES MILITARY OR NAVAL SERVICE DURING PEACETIME ONLY DID YOU PARTICIPATE IN A CAMPAIGN OR EXPEDITION AND RECEIVE A CAMPAIGN BADGE OR SERVICE MEDAL?(A) ARE YOU A DISABLED VETERAN?If so, and you have not listed your disability in answer to Item 33, explain in Item 39 below.(C) ARE YOU A VETERAN WITH WHO HAS NOT BEEN REMARRIED?I CERTIFY that the statements made by me in this application are true, complete, and correct to the best of my knowledge and belief, and are made in good faith.